Every finding on record at Virginia Healthcare Services

An unannounced Home Health Agency Medicare Medicaid recertification survey was conducted January 9-11, 2023 by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. In conjunction with the survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies.

An unannounced Medicare Medicaid Home Health Agency recertification survey was conducted January 9-11, 2023 at the above captioned agency by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. The agency reported 2209 unduplicated admissions in the last twelve (12) months with an active census of 389 patients. The following were completed/reviewed in conjunction with the survey: Seven (7) home visits, seventeen (17) clinical records, six (6) personnel files, review of selected policies and procedures, the agency's complaint log, emergency preparedness plan, and Covid vaccination records. Interviews were also conducted. A deficiency was identified and cited in this report. The agency was found to be out of compliance with 42 CFR 484, Conditions of Participation for Home Health Agencies (HHAs).

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on interviews and a review of agency documents, it was determined agency staff failed to document coordination of care to ensure patients received the necessary care for three (3) of seventeen (17) clinical records reviewed in the survey sample (clinical record #6, 12, and 13). The findings were: The electronic clinical records were reviewed in read only mode from January 9 -11, 2023. Clinical record #6 was reviewed for the certification period of 12/19/2022 through 2/22/2023. The plan of care contained orders for the skilled nurse to visit one (1) time per week for six (6) weeks. On 12/29/2022 and 1/05/2023 the nurse failed to make a visit and documented there was no answer when attempting to call the patient to schedule a visit. The clinical record failed to contain documentation of additional attempts to reach the patient. The clinical record failed to contain documentation of care coordination with the physical therapist who was seeing the patient two (2) times per week without difficulty in getting in contact with the patient. An interview with the Director of Nursing, staff #2 on 1/11/2022 at approximately 2 PM revealed not reaching out to the other discipline in the home is a problem and should have been done. Clinical record #12 was reviewed for the certification period of 12/06/2022 through 2/03/2023. The Plan of care contained orders for home health aide services two (2) times per week for four (4) weeks. The aide only made visits for one (1) week (12/14/2022 and 12/16/2022) The record failed to contain documentation of why no further visits were made. The plan of care contained orders for Physical therapy (PT) to provide services two (2) times per week for two (2) weeks and one (1) time per week for six (6) weeks. The PT only went for two (2) weeks on 12/13/2022, 12/16/2022, 12/19/2022 and 12/22/2022. The clinical record failed to contain documentation of why no further visits were made. A home visit was made to the patient on 11/10/2023 at 9 am. Prior to entering the residence, an interview was conducted with the Occupational therapist (OT), staff #3 who was visiting the patient. The OT reports being out for several weeks and not sure why the other disciplines had stopped coming but had sent a message to the supervisor this morning as it was time to discharge the patient from OT and it was necessary to know the status of the other disciplines in order to know if OASIS needed to be completed to discharge the patient from the agency. An interview with the patient and patient caregiver during the home visit revealed they thought that the visit stopped due to insurance or no physician to sign the plan of care as the patient was switching attending physicians. An interview with the Director of Nursing, staff #2 at approximately 2 PM on 1/11/2023 revealed the problem is with the patient's insurance not approving further visits and it should have been communicated with the team, patient, and documented in the record. Clinical record #13 was reviewed for the certification period of 12/17/2022 through 2/14/2023. The plan of care contained orders for physical therapy (PT) visits one (1) time per week times one (1) 12/25/2022. A note on 12/23/2022 from the PT stated call to patient, no answer. No further attempts were documented to contact the patient and no coordination notes were documented with the other members of the team seeing the patient (skilled nursing, home health aide and occupational therapist) in order to make contact with the patient to schedule a visit. An interview was conducted with the Director of Nursing, staff #2 on 1/11/2023 at 2:15 PM. Staff #2 stated further attempts should have been made and PT will reach out to schedule a visit. A revied of the agency policy on "Coordination of Patient Care" says in part: Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. Coordination of agency's internal resources includes: assuring all involved staff members are aware of patients plan of care. Making patient information available to all staff. Development of complementary actions and goals when patient receives more than one service.